Recommendations: Establishing Trust in Health Communications

To improve health outcomes in the Black community, building trust between patients and health care providers and between patients and public health experts is critical. Building a culture of trust requires a combination of actions that mitigate the creation and dissemination of medical misinformation, empower Black patients through digital health literacy, and reduce racial biases between patients and providers.

To establish trust between the Black community and the U.S. health care system, the following recommendations should be considered:

1. Pass the Promoting Public Health Information Act (H.R. 1004/S. 406)

The Promoting Public Health Information Act is intended to counter the threat of misinformation and disinformation on public health. If passed, it would support the Department of Health and Human Services (HHS) and other public health stakeholders to communicate effectively during public health emergencies and combat health misinformation more generally. It would establish a Public Health Information and Communications Advisory Committee and fund the development of evidence-based initiatives to educate the public. Passing this vital piece of legislation would be instrumental in combatting health misinformation.

2. Improve Digital Health Literacy in the Black Community

Equitable access to internet services and digital skills programs are foundational to increasing digital literacy skills in Black communities. Furthermore, as social media becomes increasingly central to the spread of health information, curriculums for Black students must include trainings on how to discern credible sources from those that are not.

3. Increase Representation in the Medical Field

Trust is foundational to healthy patient-provider relationships. Numerous studies show that trust between patients and providers is more readily developed when both people share a common race or ethnicity.23 A 2023 study found that every 10% increase in Black primary care providers was associated with an increase in life expectancy by about thirty days, as well as a 1.2% lower disparity between Black and white individuals in all-cause mortality.24 Bias and discrimination are substantial barriers to health equity. When a provider can see patients for more than just their racial and socioeconomic characteristics, they can more accurately treat them. Moreover, patients are more likely to believe that the provider has their best interest in mind, positively impacting their overall health behaviors and adherence to medical advice and treatment.

Conclusion

Disseminating reliable and accurate information about health matters is critical to public health. Health disparities have always existed for Black Americans, but online health misinformation threatens to worsen the collective health behaviors and outcomes for the Black community. Misinformation via online platforms plays off the deep mistrust the Black community already feels toward medical institutions, amplifying existing health disparities. Combating misinformation and establishing trust between Black patients and the medical community is essential to ameliorating racial health disparities.

References

1 Scharff, Darcell P., Katherine J. Mathews, Pamela Jackson, Jonathan Hoffsuemmer, Emeobong Martin, and Dorothy Edwards. “More than Tuskegee: Understanding Mistrust about Research Participation.” Journal of Health Care for the Poor and Underserved 21, no. 3 (August 2010): 879–97. https://doi.org/10.1353/hpu.0.0323

2 Hoffman, Kelly M., Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver. “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites.” Proceedings of the National Academy of Sciences 113, no. 16 (April 19, 2016): 4296–4301. https://doi.org/10.1073/pnas.1516047113

3 Meghani, Salimah H., Eeeseung Byun, and Rollin M. Gallagher. “Time to Take Stock: A Meta-Analysis and Systematic Review of Analgesic Treatment Disparities for Pain in the United States.” Pain Medicine (Malden, Mass.) 13, no. 2 (February 2012): 150–74. https://doi.org/10.1111/j.1526-4637.2011.01310.x

4 Fletcher, Michael A. “Poll: Black Americans See a Health-Care System Infected by Racism.” National Geographic, October 16, 2020. https://www.nationalgeographic.com/history/article/black-americans-see-health-care-system-infected-racismnew-poll-shows

5 Eack, Shaun M., Amber L. Bahorik, Christina E. Newhill, Harold W. Neighbors, and Larry E. Davis. “Interviewer-Perceived Honesty Mediates Racial Disparities in the Diagnosis of Schizophrenia.” Psychiatric Services (Washington, D.C.) 63, no. 9 (September 1, 2012): 875–80. https://doi.org/10.1176/appi.ps.201100388

6 Ryn, M. van, and J. Burke. “The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients.” Social Science & Medicine (1982) 50, no. 6 (March 2000): 813–28. https://doi.org/10.1016/s0277-9536(99)00338-x

7 Southwell, Brian G., Jessica Otero Machuca, Sabrina T. Cherry, Melissa Burnside, and Nadine J. Barrett. “Health Misinformation Exposure and Health Disparities: Observations and Opportunities.” Annual Review of Public Health 44 (April 3, 2023): 113–30. https://doi.org/10.1146/annurev-publhealth-071321-031118

8 Goldwire, Micheline Andel, Steven T. Johnson, Maha Abdalla, Ashish Advani, Allison Bernknopf, Angela Colella, Heather A. Kehr, et al. “Medical Misinformation: A Primer and Recommendations for Pharmacists.” JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 6, no. 5 (May 2023): 497–511. https://doi.org/10.1002/jac5.1760

9 Ibid.

10 Scherer, Laura D., Jon McPhetres, Gordon Pennycook, Allison Kempe, Larry A. Allen, Christopher E. Knoepke, Channing E. Tate, and Daniel D. Matlock. “Who Is Susceptible to Online Health Misinformation? A Test of Four Psychosocial Hypotheses.” Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association 40, no. 4 (April 2021): 274–84. https://doi.org/10.1037/hea0000978

11 Christy, Shannon M., Clement K. Gwede, Steven K. Sutton, Enmanuel Chavarria, Stacy N. Davis, Rania Abdulla, Chitra Ravindra, Ida Schultz, Richard Roetzheim, and Cathy D. Meade. “Health Literacy among Medically Underserved: The Role of Demographic Factors, Social Influence, and Religious Beliefs.” Journal of Health Communication 22, no. 11 (November 2017): 923–31. https://doi.org/10.1080/10810730.2017.1377322

12 Southwell, Brian G., Jessica Otero Machuca, Sabrina T. Cherry, Melissa Burnside, and Nadine J. Barrett. “Health Misinformation Exposure and Health Disparities: Observations and Opportunities.” Annual Review of Public Health 44 (April 3, 2023): 113–30. https://doi.org/10.1146/annurev-publhealth-071321-031118

13 Wang, Yuxi, Martin McKee, Aleksandra Torbica, and David Stuckler. “Systematic Literature Review on the Spread of Health-Related Misinformation on Social Media.” Social Science & Medicine 240 (November 1, 2019): 112552. https://doi.org/10.1016/j.socscimed.2019.112552

14 Goldwire, Micheline Andel, Steven T. Johnson, Maha Abdalla, Ashish Advani, Allison Bernknopf, Angela Colella, Heather A. Kehr, et al. “Medical Misinformation: A Primer and Recommendations for Pharmacists.” JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 6, no. 5 (May 2023): 497–511. https://doi.org/10.1002/jac5.1760

15 Mastantuono, Molly. “Why Social Media Is a Source of Strength for Black Americans.” Bentley University, February 24, 2023. https://www.bentley.edu/news/why-social-media-source-strength-black-americans

16 Florini, Sarah. “Beyond Hashtags.” NYU Press (blog). Accessed May 12, 2023. https://nyupress.org/9781479813056/ beyond-hashtags

17 Goldwire, Micheline Andel, Steven T. Johnson, Maha Abdalla, Ashish Advani, Allison Bernknopf, Angela Colella, Heather A. Kehr, et al. “Medical Misinformation: A Primer and Recommendations for Pharmacists.” JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 6, no. 5 (May 2023): 497–511. https://doi.org/10.1002/jac5.1760

18 Kuru, Ozan, Scott W. Campbell, Joseph B. Bayer, Lemi Baruh, and Richard S. Ling. “Reconsidering Misinformation in WhatsApp Groups: Informational and Social Predictors of Risk Perceptions and Corrections.” International Journal of Communication 17, no. 0 (March 13, 2023): 23. https://ijoc.org/index.php/ijoc/article/view/19590

19 Nielsen. “Nielsen Examines the Digital Habits and Impact of Black Consumers.” Accessed May 12, 2023. https://www.nielsen.com/news-center/2018/nielsen-examines-the-digital-habits-and-impact-of-black-consumers/

20 Black Twitter: A word to describe the collective identity of black users on Twitter

21 Collins-Dexter, Brandi. “Canaries in the Coal Mine: COVID-19 Misinformation and Black Communities.” Shorenstein Center (blog), June 24, 2020. https://shorensteincenter.org/canaries-in-the-coal-mine/

22 https://themarkup.org/newsletter/citizen-browser/official-info-on-covid-19-is-reaching-fewer-black-people-on-facebook

23 Huerto, Ryan. “Minority Patients Benefit From Having Minority Doctors, But That’s a Hard Match to Make.” University of Michigan Medicine, March 31, 2020. https://www.michiganmedicine.org/health-lab/minority-patients-benefit-havingminority-doctors-thats-hard-match-make

24 Snyder, John E., Rachel D. Upton, Thomas C. Hassett, Hyunjung Lee, Zakia Nouri, and Michael Dill. “Black Representation in the Primary Care Physician Workforce and Its Association With Population Life Expectancy and Mortality Rates in the US.” JAMA Network Open 6, no. 4 (April 14, 2023): e236687. https://doi.org/10.1001/jamanetworkopen.2023.6687